﻿@using Newtouch.Common.Operator;
@{
    ViewBag.Title = "Form";
    Layout = "~/Views/Shared/_Form.cshtml";
}
<style>
    span {
        color: red;
    }
</style>
<script src="~/Content/js/SystemManage/SysChargeItem/Form.js" type="text/javascript"></script>
<form id="form1">
    <table class="form">
        <tr>
            <td class="formTitle">有效<span>*</span></td>
            <td class="formValue">
                <div class="btn-group" data-toggle="buttons">
                    <label class="btn btn-default">
                        <input type="radio" name="zt" id="zt" value="1" class="form-control"> 是
                    </label>
                    <label class="btn btn-default">
                        <input type="radio" name="zt" id="zt" value="0" class="form-control"> 否
                    </label>
                </div>
            </td>
            <td class="formTitle"></td>
            <td class="formValue"></td>
        </tr>
        <tr>
            <td class="formTitle">代码</td>
            <td class="formValue"><input type="text" class="form-control newtouch_Readonly" name="sfxm" id="sfxm" /></td>
            <td class="formTitle">自负性质<span>*</span></td>
            <td class="formValue">
                <select class="form-control" id="zfxz" name="zfxz">
                    <option value="">==请选择==</option>
                    <option value="0">可报</option>
                    <option value="1">自费</option>
                    <option value="2">分类自负</option>
                    <option value="3">绝对自费</option>
                </select>
            </td>
        </tr>
        <tr>
            <td class="formTitle">收费项目<span>*</span></td>
            <td class="formValue"><input type="text" class="form-control" name="sfxmmc" id="sfxmmc" /></td>
            <td class="formTitle">拼音<span>*</span></td>
            <td class="formValue"><input type="text" class="form-control" name="py" id="py" /></td>
        </tr>
        <tr>
            <td class="formTitle">单位<span>*</span></td>
            <td class="formValue"><input type="text" class="form-control" name="dw" id="dw" /></td>
            <td class="formTitle">单价<span>*</span></td>
            <td class="formValue"><input type="text" class="form-control" name="dj" id="dj" /></td>
        </tr>
        <tr>
            <td class="formTitle">范围<span>*</span></td>
            <td class="formValue">
                <select class="form-control" id="mzzybz" name="mzzybz">
                    <option value="">==请选择==</option>
                    <option value="0">通用</option>
                    <option value="1">门诊</option>
                    <option value="2">住院</option>
                </select>
            </td>
            <td class="formTitle">自付比例<span>*</span></td>
            <td class="formValue"><input type="text" class="form-control" id="zfbl" name="zfbl" /></td>
        </tr>
        <tr>
            <td class="formTitle">特殊<span>*</span></td>
            <td class="formValue">
                <div class="btn-group" data-toggle="buttons">
                    <label class="btn btn-default">
                        <input type="radio" name="tsbz" id="tsbz" value="1" class="form-control"> 是
                    </label>
                    <label class="btn btn-default">
                        <input type="radio" name="tsbz" id="tsbz" value="0" class="form-control"> 否
                    </label>
                </div>
            </td>
            <td class="formTitle">警示<span>*</span></td>
            <td class="formValue">
                <div class="btn-group" data-toggle="buttons">
                    <label class="btn btn-default">
                        <input type="radio" name="jsbz" id="jsbz" value="1" class="form-control"> 是
                    </label>
                    <label class="btn btn-default">
                        <input type="radio" name="jsbz" id="jsbz" value="0" class="form-control"> 否
                    </label>
                </div>
            </td>
        </tr>
        <tr>
            <td class="formTitle">收费<span>*</span></td>
            <td class="formValue">
                <div class="btn-group" data-toggle="buttons">
                    <label class="btn btn-default">
                        <input type="radio" name="sfbz" id="sfbz" value="1" class="form-control"> 是
                    </label>
                    <label class="btn btn-default">
                        <input type="radio" name="sfbz" id="sfbz" value="0" class="form-control"> 否
                    </label>
                </div>
            </td>
            <td class="formTitle">实施<span>*</span></td>
            <td class="formValue">
                <div class="btn-group" data-toggle="buttons">
                    <label class="btn btn-default">
                        <input type="radio" name="ssbz" id="ssbz" value="1" class="form-control"> 是
                    </label>
                    <label class="btn btn-default">
                        <input type="radio" name="ssbz" id="ssbz" value="0" class="form-control"> 否
                    </label>
                </div>
            </td>
        </tr>
        <tr>
            <td class="formTitle">大类<span>*</span></td>
            <td class="formValue">
                <input type="text" class="form-control" id="dlmc" name="dlmc" />
            </td>
            <td class="formTitle">分类</td>
            <td class="formValue"><input type="text" class="form-control" id="flmc" name="flmc" /></td>
        </tr>
        <tr>
            <td class="formTitle">医保代码</td>
            <td class="formValue">
                <input type="text" class="form-control" id="ybdm" name="ybdm" />
            </td>
            <td class="formTitle">物价代码</td>
            <td class="formValue"><input type="text" class="form-control newtouch_Readonly" id="wjdm" name="wjdm" /></td>
        </tr>
        <tr>
            <td class="formTitle">农保大类</td>
            <td class="formValue"><input type="text" class="form-control" id="nbdlmc" name="nbdlmc" /></td>
            <td class="formTitle">病案大类</td>
            <td class="formValue"><input type="text" class="form-control" id="badlmc" name="badlmc" /></td>
        </tr>
        <tr>
            <td class="formTitle">建档人员</td>
            <td class="formValue">
                <input class="form-control" id="CreatorCode newtouch_Readonly" name="CreatorCode" value=@OperatorProvider.GetCurrent().UserCode type="text" />
            </td>
            <td class="formTitle">建档日期</td>
            <td class="formValue">
                <input class="form-control" id="CreateTime newtouch_Readonly" name="CreateTime" value=@DateTime.Now type="text" />
            </td>
        </tr>
    </table>
</form>